Efficacy of Combined Plasmapheresis and Intravenous Immunoglobulin Therapy in Kidney Transplant Patients With Chronic Antibody-mediated Rejection

Introduction. Antibody-mediated rejections (AMRs) are critical clinical issues encountered in short- and long-term follow-up of kidney transplant patients. Whereas plasmapheresis is a mainstay treatment option in acute AMR cases, there is a paucity of data regarding its efficacy in management of chronic AMR. This report describes our experience addressing this issue. Materials an‎d Methods. We retrospectively investigated the data of 7 kidney transplant patients diagnosed with chronic AMR who were on 5 sessions of plasmapheresis (1 to 2 volume exchanges with fresh frozen plasma) on alternate days and 200 mg/kg of intravenous immunoglobulin after each session of plasmapheresis. Results. At 6 months after the initiation of treatment, 6 patients experienced partially improved kidney function. One patient had no response and her kidney function progressively deteriorated. Conclusions. Our preliminary results are encouraging for the combination of plasmapheresis and intravenous immunoglobulin as an adjunctive therapy for kidney transplant patients suffering from chronic AMR.